650023 (2).pdfa
PLAN FILE NUMBER BUILDING
'a1pplicant FIR PERMIT
pplication side Heavy Lines 4' NU1SfBEI?(-,,5nn23
Building Permit A
NAME (OR NAME OF BUSINESS) JOB ADDRESS
A IQ 5&�
MAILING ADDRESS SIDE YARD SET BACK REAR YARD
(o D. j ;2j
CITY TELEPHONE NUMBlalt USPAONE MAP NUMBER VAL;ANT SITE
icd 1 / 7,,.2 [] YES 0 NO 0
NAME �) BUILDING AREA I LOT AREA VARIANCE NUMBER
(,-�X& Le. av\ rT A IV; AJ �1&0
ADDRESS HEIGHT ALL BUILDING SETBACKS
ls� NOTE: TO E&VE LINES
C1'ry -R REMARKS
G±t J)j �j TELEPHONE NUMBF
NAME
AIJUnESIS Ot..' Encroachment Permit PERMIT NUMBER�STREET GRADE CHECK
Required I I
CITY TELEPHONE NUMBER METER SIZE SERVICE SIZE I CLEARANCE CHECKED 33Y
STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS
BLOCK TAXP
LOT T
TYPE C N C rIOIJ VERIFIED BY
PERM TEST PERMIT NUMBER
J,
FIRE ZON TYPE OF CONSTRUCTION STREET IMPROVED
YES [3 No
0 SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES
PLAN CHECKED BY
94
0 WORK TO BE DONE
0 NO. OF 8LoGs. -PtrRIBLOG. ___LOTAL. FKrE Z
BUILDING 0
1 VALUATION
BUILDING PERMIT
NUMBER OF STORIE 2 FEE 4- 6� 3— 0 In
NEW IDEMOU13H PLUMBING
ADD PERMIT FEE
N71 HEAT & GAS LINE
ALTER LI-N PERMIT FEE
Q RESIDENTIAL NUMBER OF 4
DWELLING
REPAIR NON-RESIDENTIAL UNITS DEMOLITION
1:1 1:1 1 5 PERMIT FEE
PROPOSE��JXLPF,
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author. ATTENTION APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws rega-
THIS PERMIT This application is not a permit until
lating construction; and in doing the work authorized thereby, no person AUTHORIZES signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION DIRECTOR'S SIGNATURE
Ti5R'—kT-UW (OWNBR�OR 4GENT) D TE SIGNED
DEPARTMENT
71 CITY OF
DATE
PLOT P HE & AP ROVED EDMONDS
PR 0-1107
FILE
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